Sedowofia K, Barclay C, Quaba A, Smith A, Stephen R, Thomson M, Watson A, McIntosh N
Department of Child Life and Health, University of Edinburgh, UK.
Clin Endocrinol (Oxf). 1998 Sep;49(3):335-41. doi: 10.1046/j.1365-2265.1998.00553.x.
Thermal injury is extremely stressful, but data characterizing the endocrine stress response to this injury in children are sparse. The objective of this study was to measure the effects of thermal injury on the levels of stress hormones in children and to assess the temporal changes associated with them.
Twenty-three children, 13 girls and 10 boys aged between 5 months and 12 years 3 months (mean, 2 years 11 months), with burns covering 10-61% of their body surface (mean, 20.5%) were studied during the first 5 days following injury.
The levels of arginine vasopressin, angiotensin II, cortisol, adrenaline, noradrenaline and dopamine were measured in sequential blood samples obtained from thermally injured children on admission and at specified time intervals during the 5 days of the investigation.
At admission the concentrations of all the hormones were high, and varied widely between individual patients. The geometric mean and 95% confidence intervals of admission hormone levels were as follows: arginine vasopressin 18.3 (8.3-40.7) pmol/l; angiotensin II 122.0 (56.0-266.2) pmol/l; cortisol 650.6 (473.0-895.0) nmol/l; dopamine 1.0 (0.1-8.0) nmol/l; adrenaline 6.4 (3.2-12.5) nmol/l and noradrenaline 2.3 (1.3-4.3) nmol/l. Although the concentrations of arginine vasopressin and cortisol returned to normal 24 to 36 h after admission, the levels of angiotensin II, adrenaline and dopamine fluctuated and remained higher than normal throughout the study (108 h).
Thermal injury results in the release of abnormally high levels of stress hormones in children. Although there are similarities between some of the data reported here and those reported in adults, higher levels of adrenaline and lower levels of noradrenaline than reported in adults suggest important differences too. These differences may need to be taken into account in the management of burn-injured children.
热损伤极具应激性，但有关儿童对这种损伤的内分泌应激反应的特征数据却很稀少。本研究的目的是测量热损伤对儿童应激激素水平的影响，并评估与之相关的时间变化。
23名儿童，13名女孩和10名男孩，年龄在5个月至12岁3个月之间（平均2岁11个月），烧伤面积占体表的10%-61%（平均20.5%），在受伤后的前5天进行了研究。
在热损伤儿童入院时以及研究的5天内的特定时间间隔采集的连续血样中，测量精氨酸加压素、血管紧张素II、皮质醇、肾上腺素、去甲肾上腺素和多巴胺的水平。
入院时所有激素的浓度都很高，且个体患者之间差异很大。入院时激素水平的几何平均值和95%置信区间如下：精氨酸加压素18.3（8.3-40.7）pmol/l；血管紧张素II 122.0（56.0-266.2）pmol/l；皮质醇650.6（473.0-895.0）nmol/l；多巴胺1.0（0.1-8.0）nmol/l；肾上腺素6.4（3.2-12.5）nmol/l；去甲肾上腺素2.3（1.3-4.3）nmol/l。尽管精氨酸加压素和皮质醇的浓度在入院后24至36小时恢复正常，但血管紧张素II、肾上腺素和多巴胺的水平波动，并在整个研究期间（108小时）一直高于正常水平。
热损伤导致儿童释放异常高水平的应激激素。尽管此处报告的一些数据与成人报告的数据有相似之处，但与成人相比，肾上腺素水平较高而去甲肾上腺素水平较低也表明存在重要差异。在烧伤儿童的治疗中可能需要考虑这些差异。
